Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
Nephrol Dial Transplant. 2019 Apr 1;34(4):711-717. doi: 10.1093/ndt/gfy256.
Tubular basement membrane immune deposits (TBMID) has rarely been observed in renal allografts. It is usually found in BK virus nephropathy and immune complex glomerulonephritis; however, its significance is not well understood. We conducted a retrospective clinicopathological study on monoclonal immunoglobulin G (IgG) TBMID.
We studied 7177 renal allograft biopsy specimens obtained from Tokyo Women's Medical University from 2007 to 2015 and performed light microscopic, electron microscopic and immunofluorescence studies.
Tubular basement membrane (TBM) deposits of IgG were found in 73 biopsies from 61 patients and the IgG subclass was obtained in 31 biopsies. There were no cases of monoclonal IgA or IgM TBMID. In total, 13 biopsies from 10 patients showed monoclonal IgG TBMID. Of these, seven showed monoclonal IgG1κ TBMID and one each showed monoclonal IgG2κ, IgG2λ and IgG3κ TBMID. Conversely, eight patients showed polyclonal IgG TBMID. In electron microscopy, large granular electron-dense deposits (EDDs) in the TBM were detected in all patients with monoclonal IgG1κ TBMID. EDDs were absent in TBM in patients with monoclonal IgG2κ, IgG2λ or IgG3κ TBMID. Progression of interstitial fibrosis and tubular atrophy (IFTA) was significantly higher in patients with monoclonal IgG1κ TBMID than in those with polyclonal IgG TBMID (P < 0.05). There were no significant differences in the other clinical parameters between monoclonal IgG1κ and polyclonal IgG TBMID.
This is the first study of patients with monoclonal IgG TBMID in renal allografts. We found that monoclonal IgG1κ TBMID was associated with EDD formation in TBM and IFTA progression.
管状基底膜免疫沉积物（TBMID）在肾移植中很少见。它通常见于 BK 病毒肾病和免疫复合物性肾小球肾炎，但它的意义尚未被很好地理解。我们对单克隆免疫球蛋白 G（IgG）TBMID 进行了回顾性临床病理研究。
我们研究了 2007 年至 2015 年期间东京女子医科大学的 7177 例肾移植活检标本，进行了光镜、电镜和免疫荧光研究。
在 61 例患者的 73 例活检中发现 IgG 管状基底膜（TBM）沉积物，在 31 例活检中获得了 IgG 亚类。没有单克隆 IgA 或 IgM TBMID 的病例。总共 13 例来自 10 例患者的活检显示单克隆 IgG TBMID。其中，7 例为单克隆 IgG1κ TBMID，1 例为单克隆 IgG2κ、IgG2λ 和 IgG3κ TBMID。相反，8 例患者显示多克隆 IgG TBMID。在电子显微镜下，所有单克隆 IgG1κ TBMID 患者的 TBM 中均检测到大颗粒电子致密沉积物（EDD）。在 TBM 中未发现单克隆 IgG2κ、IgG2λ 或 IgG3κ TBMID 的 EDD。单克隆 IgG1κ TBMID 患者的间质纤维化和肾小管萎缩（IFTA）进展明显高于多克隆 IgG TBMID 患者（P<0.05）。单克隆 IgG1κ 和多克隆 IgG TBMID 之间在其他临床参数上无显著差异。
这是首例肾移植中单克隆 IgG TBMID 患者的研究。我们发现，单克隆 IgG1κ TBMID 与 TBM 中的 EDD 形成和 IFTA 进展有关。
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